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Revista de la Asociación Española de Neuropsiquiatría

On-line version ISSN 2340-2733Print version ISSN 0211-5735


VILLAGRAN, José M.; LARA RUIZ-GRANADOS, Ignacio  and  GONZALEZ-SAIZ, Francisco. The shared decision-making process in the treatment of psychiatric patient: empirical studies and capacity assessment. Rev. Asoc. Esp. Neuropsiq. [online]. 2014, vol.34, n.123, pp.491-506. ISSN 2340-2733.

There is empirical research on shared decision making in mental health, above all in depression and schizophrenia, and somewhat less in addictions. Studies carried out in recent years produce evidence showing that it improves the quality of decisions and it seems to be effective in decision making (increased knowledge and participation, promotes greater consistency with the patient values and preferences), increasing user satisfaction mostly. However, there is tiny evidence of its effectiveness on health outcomes. One of the key elements of shared decision-making processes is the determination of the patient's capacity to make the clinical decisions in question. This is an assessment that has a core role in the delicate balance between autonomy and beneficence / non-maleficence in health care. Thus, a proper assessment of the capacity of the patient to make decisions might be useful to protect both principles and to avoid two types of errors: first, to ignore unjustifiably the patient autonomy to safeguard their welfare, and secondly, the unwarranted respect for their autonomy for the price of their welfare.

Keywords : decision making; psychiatry; therapeutics; medication adherence; ethics; mental competency.

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